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WGU D118 OBJECTIVE ASSESSMENT FINAL EXAM 3
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WGU D118 OBJECTIVE ASSESSMENT FINAL EXAM A
A patient reports chronic nasal obstruction and recurrent epistaxis. Which type of nasal mass is likely?
- Inverted papilloma
- Nasal polyp
- Paranasal lymphoma
- Squamous cell carcinoma
ANS: A
Inverted papillomas are benign tumors of the nasal mucosa and are highly vascular with frequent bleeding. Nasal polyps typically do not bleed and are associated with allergies.Paranasal lymphoma and squamous cell carcinoma are not initially associated with bleeding.A patient reports chronic nasal obstruction and difficulty distinguishing smells. The provider examines the nares with a nasal speculum and observes several grape-like lesions in both nostrils. What is the likely cause of this patient's symptoms?
- Chronic sinusitis
- Nasal polyps 1 / 4
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- Squamous cell carcinoma
- Vascular benign tumor
ANS: B
Polyps cause obstruction and olfactory dysfunction and appear as grape-like lesions on the nasal mucosa. Most malignant neoplasms are asymptomatic until late in the course. Chronic sinusitis characteristically produces inflammation and purulent discharge.A provider examines a patient who has chronic nasal obstruction, respiratory tract symptoms, and generalized malaise. An examination of the nasal mucosa reveals ulceration of the nasal septum. What is the most important action when caring for this patient?
- Administering prednisone
- Obtaining a chest radiograph
- Performing laboratory tests
- Referring to a specialist
ANS: D
This patient has symptoms of granulomatosis with polyangiitis (GPA) and should be referred as soon as the disease is suspected. The other actions will be taken, but referral is the most important.A 58-year-old man presented to the hospital with right-sided decreased hearing for two years. His wife mentions he has started snoring recently. He has been a smoker for the last 25 years and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy.Which key anatomical area is the pathology most likely to be situated in?
- Right Middle Meatus 2 / 4
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- The roof of the nasal cavity
- Right vallecula
- Postnasal space
ANS: D
In a patient with recent-onset unilateral hearing loss and nasal obstruction with a social history of smoking one must rule out a nasopharyngeal pathology most likely a malignancy. • Any mass in the nasopharynx can obstruct the medial ends of the eustachian tube leading to problems with the ears. • Nasopharyngeal cancer can arise from the fossa of Rosenmüller, which lies behind the eustachian tubes on either side. So a clear look at this area with a nasendoscopy in high-risk patients with unilateral middle ear effusion is mandatory. • Malignancies in the other anatomical areas mentioned are obviously possible, but will not cause unilateral middle ear effusion with conductive hearing loss.A patient with systemic lupus erythematosus (SLE) develops end-stage renal disease. Because of the underlying SLE, what treatment is recommended for this patient?
- Dialysis only
- Immunosuppressant therapy
- Kidney transplantation
- Palliative care
ANS: C
Patients with SLE who develop renal failure may require dialysis and then kidney transplantation; most who undergo transplant do relatively well because of the immunosuppression given to prevent graft rejection. Immunosuppressant therapy is given for 3 / 4
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- Prescribe tacrolimus
- Increase the dose of cyclosporine
- Prescribe amoxicillin
- Prescribe paracetamol
ANS: A
Tacrolimus is efficient more than ten folds when compared to cyclosporine. • Calcineurin inhibitors' dosages should be monitored cautiously as an increase in its blood concentration could cause many complications like kidney failure. • Cyclosporine, tacrolimus, and pimecrolimus are called calcineurin inhibitors because they inhibit the enzyme "calcineurin" that is responsible for T-cell activation. • Tacrolimus is used as an adjuvant to other immunosuppressive drugs to avoid organ rejection.A 28-year-old primigravida presented to the antenatal clinic for a routine check-up. She has been exposed to someone with chickenpox but has not developed any skin lesions. She has no varicella-zoster antibodies. What would be the best possible treatment for her?
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